HomeMy WebLinkAboutT12N R3W SEC 8 SW4SW4SE4 PTN PARCEL 22 GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
Fl{/q
Approval requested by:
Mailing Address:
Property Owner:
Time of Inspection /'~: ~o /¢~27
Date of Inspection /-/~-~ ?~
Phone: ~??-o~
Phone: ~-~mm,z~
3. Legal Descrlptlo.n~ Z~..Z ~__~ 2~/~.~--~cd~ ~;t~ K~
5. Type of facility to be inspected~c~~/~-- No. of bedrooms
6, Well Data: / / /~
A, Type _~b)~, B, Depth ~/~2 /
C. Construction
D. Bacterial Analysis
Sewage Disposal System: O6~pa-mL -/L~</ ~/~/~
A. Installed ~/0/~ /~}~/ B. Installer
C, Septic Tank: 1. Size 2. Manufacturer
D. Seepage Pit: 1. Absorption Area 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A, Well to: Septic tank
, Absorption area
Sewer Lines
Nearest lot line
Other contamination
B. Foundation to septic tank
., Absorption area
C. Absorption area to nearest lot line
EQ-034 (1174) Page 1 of two pages
Page 2 of two pages - Req for Approval of Individual S & Water Facilities
Approved Disapproved Date
Approval~Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Qualit~
DIAGRAM OF SYSTEM
^f
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water 'facilities and these facilities
are operating satisfactorily.
SIGNED Date
EQ-034 (1174)
3330
REQdEST FOR APPko'gAL OF
INDIVIDUAL ~; ,.R & W!fFI[R FACILITIES
, pe,,.,.i on: gMRO VA ...... FHA ___~___
Type o'f .:ns ..... , ...... CONV
Fmiling Afidress:
Day Phone
Name n'f :~-,.t.; ..... .t : Alber% ~_~i,__~.lNNiNrt~z
fqailing Address:
D=,, Phone 24L9 :._F:~Li1
Name of Realtor or Agent:
Mailing Address: _]10__3j Cordova S~ree't
Legal Descriptio'/~-:. Sec 8 T12N..~W
I_ocati on: South of 88
Type oF Facil'~ty to be inspected: _S_~:~Le ..................
Water .~iuppl y
,., I i t.v ....... ' ~
Type nf Supply: Public ' "~ Ind,vldual
if Indiv'idual ;!u;':ber .), dN..,e~ll~lgs presell'c, ly served
If ]Znc,!v duc, (.e,~r~'~.,1 of ..... i _ ....
· I .... Foss,, S.ys
waqe ~': ~'" "':'
Type of f.;vst.e'.~: Public Utility ....... Individual (on-site) .......
I-f Individual, d~'ce of ins't~llation
'( ,./ 13^re
.PARTMEN'[ OF HEALTH AND SOCIAL SEl,.,,,.,:o
DIVISION OF'PUBLIC HEALTH LobNo.
BACTERIOLOG I CA'-L~ WATER ANALYSIS
ZIP CODe__~ ,~"
SANITARIAN'S REMARKS
COMPLETE THIS SECTION
ONLY IF WA'rER IS AN INDIVIDUAl. SUPPLY
DATECOLIECTED ti/ % / ]",. TIMECOL£ECTEE - ·
READ NSI'RUCTIONS
ON
REVERSE SIDE
BEFORE
COLLECTING SAMPLE
06-1220 (b
Rev 1973
[] No
Ye! D No S~9norure
BACTERIOLOGICAL WATER ANAI_YSIS RECORD
LoEtose Brolh
24 Hours
I Oct I Oct
MF ResuLts __
9~44 P_J)'~7,oll Road
SEO/ljh.
4,1
tho sJoJ.,1,~ locating. U~ fotmd ~ cesspool serving ~ the m~ta~ie disposal
)'oceSpt of this notice, yok~ will have t~n (I0) d~ys to obtain
the fact that tht~ option has ht~en availabl~ to y~u fo~ ~)arly
Since)"ely,
St!:O/ljh
january 17, 21975
~tnier r.brt~lac3o Co.
P. 0,, l~>x 1200
~choraq~, .~taska
99510
S[%k]~CT; ~;~L~ anal wa-~.~,~: facilil~ies at 9044 tlal:tzoll i~3ad
I~m,~al.. Parcal 2~., S¢~'ction 8, T12M, r,~..7 5m
faotlities on the ~¢~ ~m~i'.ionc~ proi~rty.
'lh~' f~%wor sya~a ~% ~his lot ~lsis~ of a ezware]. ~i~r~dly ~s~d. lr.~l
prior ~ 1961, ~ the f~l of 1974 I~lio m~e,r wa~ ~de av~l~l~ to ~-lis
ar~ wi~l ~t.~ la~-~ral ex~iUa~g al.~l tt~tzc~]l I~ad.
This Daparb0.%nt will issue a ~r~ .~r~al of this f~tllky pm%d~ng
t~le ~scr{~.; o.f flln~ ~ l~ ~ ix~Iic ~ no la~)r ~14u1 July 1, 1975. A
well o~ .fl]is. t~cRx~rt~ is of a!l~roved conatract:[c~% ~u~d -~le bac4~zial
~u/alysia aatiSfactozy.
If you ~mva ~y qu{mtions r(ga~]i~3 the z~txYve l,le~ ~)ntact ms at 274-4561,
a~ion 146.